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The vertical expandable prosthetic titanium rib (VEPTR) is a medical device that is surgically attached to the ribs of children to treat Thoracic Insufficiency Syndrome (TIS). TIS is a congenital condition that prevents normal lung development and breathing due to chest, spine, and/or rib abnormalities. VEPTR implantation expands the area of lung space, promotes lung growth, and facilitates normal function of the lungs.


VEPTR is a curved titanium rod with hooks at both ends that is surgically attached to the ribs in a vertical position near the spine to help separate fused ribs and straighten the spine. The VEPTR is lengthened or replaced in follow-up surgical procedures to accommodate the child’s growth and ensure continued correction of the deformities.


Prior to VEPTR implantation surgery, the child should avoid crowded places and people who are sick. They should take all medications as prescribed and eat nutritiously. Flu and/or pneumonia shots may be suggested if the child is having lung issues.

The child is placed under general anesthesia and a small incision is made on the child’s back. The fused ribs are exposed and gently separated. The VEPTR is then expanded to the required length, firmly attached to the child’s ribs by its hooks, and the incision is closed with stitches.

After surgery, the child is moved to the pediatric intensive care unit for monitoring and may be placed on a ventilator for about three days to help them breathe. Adjustments and/or replacements of the VEPTR are then made during follow-up surgeries that take place at specific times in the child’s development.


  • Improvement of chest, spine, and rib deformities
  • Enables normal growth and development
  • Increased area for growth of lungs allows for increased lung capacity and decreased use of ventilators and other assistive breathing devices
  • Increased ability to participate in physical activities
  • Increased life span
  • Improvement in psycho-social health


  • Infection of the surgical incision site
  • Rejection of the titanium used in VEPTR
  • Damage to the surrounding areas, during surgery
  • Bending and breakage of VEPTR during accidents which may damage the lungs, heart and blood vessels
  • The VEPTR must be repositioned and lengthened as the child grows which requires additional surgeries and hospitalization


  • Lack bone strength in the ribs or spine
  • Do not have frontal ribs to which the VEPTR can be attached
  • Do not have a functioning diaphragm
  • Are allergic to titanium
  • Have an infection at the surgical site
  • Are less than 6 months old
  • Have reached skeletal maturity


  1. SYNTHES Spine. (n.d.). Retrieved July 23, 2014, from
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